|Year : 2016 | Volume
| Issue : 1 | Page : 14-18
Perception of gingival bleeding and oral health practices in dental anxious and nonanxious Nigerian teachers
Clement Chinedu Azodo, Agnes O Umoh
Department of Periodontics, University of Benin, Benin City, Edo, Nigeria
|Date of Web Publication||10-Aug-2016|
Clement Chinedu Azodo
Department of Periodontics, University of Benin, Benin City, Edo
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: The objective of this study was to examine the perception of gingival bleeding and oral health practices in dental anxious and nonanxious Nigerian primary school teachers. Materials and Methods: This cross-sectional was conducted among public primary school teachers in Benin City, Edo State, Nigeria. Self-administered questionnaire which elicited information on demography, dental anxiety, gingival bleeding, teeth cleaning, and dental attendance was the data collection tool. Dental anxiety was assessed using Modified Dental Anxiety Scale and participants with scores ≥19 and <19 were considered as dental anxious and nonanxious, respectively. Results: A total of 151 teachers participated in the study giving 83.9% retrieval rate. Of the 151 teachers studied, 29 of them reported dental anxiety giving 19.2% prevalence. Dental anxious participants erroneously considered gingival bleeding during teeth cleaning as the manifestation of dental caries and gingival recession more than the nonanxious participants. Dental anxious participants reported lower gingival bleeding preventive measures awareness and took more actions other than visiting the dentist for gingival bleeding than the nonanxious participants. Dental anxious participants reported more daily teeth cleaning for reasonable duration using a combination of chewing stick, toothbrush, and toothpaste than the nonanxious participants. Dental anxious participants reported more irregular dental attendance and fair/poor gingival health status than nonanxious participants. Conclusion: Data from this study revealed that dental anxious participants generally had better oral self-care practices, poorer gingival health, more irregular dental attendance, lower gingival bleeding preventive measures awareness, more erroneous belief, and took more improper steps for gingival bleeding management than the nonanxious participants.
Clinical Relevance to Interdisciplinary Dentistry
Dentists and periodontologists must take into consideration the effect of dental anxiety on oral self-care, dental attendance practices, and periodontal health to ensure holistic dental healthcare awareness, utilization, and delivery.
Keywords: Dental anxiety, dental visit, interdental aids, oral hygiene, school teachers
|How to cite this article:|
Azodo CC, Umoh AO. Perception of gingival bleeding and oral health practices in dental anxious and nonanxious Nigerian teachers. J Interdiscip Dentistry 2016;6:14-8
|How to cite this URL:|
Azodo CC, Umoh AO. Perception of gingival bleeding and oral health practices in dental anxious and nonanxious Nigerian teachers. J Interdiscip Dentistry [serial online] 2016 [cited 2019 Jun 19];6:14-8. Available from: http://www.jidonline.com/text.asp?2016/6/1/14/188156
| Introduction|| |
Gingival bleeding which is the earliest and the most common manifestation of periodontal disease is usually provoked by teeth cleaning or eating but may sometimes be spontaneous and unprovoked. It occurs most commonly as a result of plaque-induced gingival inflammation and swelling but may occasionally result from direct trauma, viral, fungal or bacterial infection, dermatoses, or as a manifestation of a systemic condition.  The adverse effects of drugs on the periodontal tissues may also result in gingival bleeding. 
Gingival bleeding has been cited as a reliable, safe, and objective clinical parameter for the evaluation of the inflammatory conditions of the periodontium. , It is an unequivocal objective sign of gingivitis and periodontitis that precede their other objective signs such as changes in color and edema.  Gingival bleeding assessment is a component of several periodontal indices which include bleeding on probing index, gingival index, and Community Periodontal Index for Need. Although gingival bleeding is neither represent a diagnosis nor does it distinguish between the various forms of associated periodontal diseases its assessment is considered, a useful clinical tool in the detection of the activity and progression of inflammatory conditions of the periodontium. 
The removal of plaque and plaque retentive factors is known as the most effective local preventive measures against gingival bleeding and the major oral diseases. This can achieve in motivated individuals by proper hygiene practices which include meticulous oral self-care and preventive dental visit. The preventive dental visit which is usually higher in informed and positively reinforced individuals is associated with dental health knowledge and better compliance with oral health care regimens. In developing countries, the impendent to preventive dental health care which include poor oral health awareness, low oral health manpower to population ratio, inequitable distribution of oral health care setting, preference of curative to preventive dental visit, and dominantly exists. The other prominent barrier to preventive dental health care is dental anxiety. Dental anxiety causes delay and avoidance of dental care leading to the deterioration of oral health, feelings of shame and embarrassment thereby posing a significant problem for the dental profession.  Dental anxiety and health behaviors of parents, directly and indirectly, affect the health of the children. ,,,, There have been reports of parental dental anxiety exerting an adverse effect on the oral health of children. , Understanding dental anxiety and relating it to gingival bleeding and other aspects of oral health among teachers is important because of the considerable influence, teachers have on pupils and to an extent on the larger community.  It may also help improve the effective utilization of teachers in preventive oral health education because a focus on dental anxiety-related behaviors of parents and by implication their significant others like teachers, is part of holistic oral disease preventive strategies in children. The objective of the study was to examine the perception of gingival bleeding and oral health practices in dental anxious and nonanxious Nigerian primary school teachers.
| Materials and methods|| |
After obtaining ethical approval was granted by the University of Benin Teaching Hospital Ethics and Research Committee, this cross-sectional study was conducted among public primary school teachers in Benin City, Edo State, Nigeria. Informed consent was obtained from the participants. The self-administered questionnaire which elicited information on demography, teeth cleaning method, frequency, and duration of each cleaning episode, interdental cleaning agents, toothbrush renewal frequency, dental visit pattern, barrier to dental visit, perception of gingival bleeding, and action taken on gingival bleeding experience, their opined best way to prevent gingival bleeding and self-rated periodontal health was the data collection tool. The questionnaire was developed by the researchers after relevant literature review and validated by experts in oral health epidemiology. Dental anxiety was assessed using Modified Dental Anxiety Scale (MDAS). The MDAS is a modification of Corah's Dental Scale by the addition of an extra item about the participant's anxiety to a local anesthetic injection. The minimum and maximum MDAS is 5 and 25, respectively. The higher MDAS indicated higher dental anxiety while lower score indicated lower dental anxiety. Individuals who scored <19 were considered as dental nonanxious participants while those with a score of 19 and above were considered as dental anxious participants. , Coker et al.  reported MDAS to have a sensitivity of 0.8, a specificity of 0.85, good internal consistency and concurrent validity coefficient. They thereafter concluded that MDAS is a useful instrument for measuring dental anxiety among Nigerians because of its reliability, validity, brevity, and ease of administration. 
In terms of analysis, the demographic characteristics in term of age was categorized into ≤40 years and >40 years, qualification as less than degree (National Certificate of Education) and greater than or equal to degree (bachelor degree, higher national diploma, master's degree, and doctor of philosophy) class taught as senior and junior, years of experience as ≤10 and >10. The data were subjected to descriptive and nonparametric Statistics Statistical Package of Social Sciences (version 17.0) (SPSS Inc. Chicago IL). The test of association was done using either Chi-square or Fisher's exact statistics. P < 0.05 for significance level.
| Results|| |
A total of 151 teachers participated in the study giving an 83.9% of retrieval rate. The majority of the participants was females, older than 40 years, experienced tutors, junior primary school class tutor, and possessed less than university degree qualification [Table 1]. Of the 151 teachers studied, 29 of them reported dental anxiety giving 19.2% prevalence. Although not statistically significant, older participants, females, those with higher educational attainment (greater than or equal to a degree), senior primary school class tutor, and more experienced tutors reported more dental anxiety [Table 2]. About three-quarters (77.5%) of the participants reported cleaning their teeth more than once-daily. Dental anxious participants reported more than once-daily teeth cleaning than nonanxious participants. More than half (53.0%) of the participants reported their average teeth cleaning duration to be more than 2 min, and this was higher among the dental anxious participants. A total of 64.2% of the participants reported cleaning their teeth with toothbrush and toothpaste which was higher among dental nonanxious participants. About a quarter (25.2%) of the participants reported cleaning their teeth with chewing stick, toothbrush, and toothpaste and this was higher among the dental anxious participants. One out of every fourteen participants use dental floss as their interdental cleaning device, and this use was higher among the dental anxious participants. Three monthly toothbrush renewal frequencies were reported by 65.6% of the participants, and this was higher among the dental anxious participants [Table 3].
More than half (51.0%) of the participants have never visited the dentist. The pattern of dental attendance was significantly different among dental anxious and nonanxious participants (P = 0.044). Dental anxious participants reported higher symptomatic dental attendance than the nondental anxious participants. The main barriers to dental attendance were not having toothache and lack of time. The perceived barriers to dental attendance were significantly different among dental anxious and nonanxious participants (P = 0.004). Dental anxious participants reported treatment as expensive, fear of dental needle, dentist, and dental clinic more than the dental nonanxious participants as their barrier to regular dental attendance [Table 4]. The majority of the participants considered bleeding gum while cleaning teeth as a manifestation of periodontal disease. Dental anxious participants erroneously considered gingival bleeding during teeth cleaning as a manifestation of dental caries and gingival recession than the dental nonanxious participants. Dental anxious participants reported taking other actions other than visiting the dentist for gingival bleeding. Tooth brushing and flossing were majorly considered as the main way of protecting oneself from gingival bleeding in this study. Dental anxious participants reported this less than dental nonanxious participants. About four-fifth of the participants rated their periodontal health as excellent/good and dental anxious participants significantly reported more fair/poor periodontal health than the nonanxious participants (P = 0.038) [Table 5].
|Table 5: Self-rated gingival health and perception of gingival bleeding among the participants |
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| Discussion|| |
There exists paucity in community-based dental anxiety information as most studies on dental anxiety in Nigeria were hospital-based. In this study, about one out of every 5 (19.2%) studied participants reported dental anxiety, and this was higher than 7.43% reported by Arigbede et al.  among patients visiting a Nigerian University Dental Centre. The difference may be explained by the effect of dental environment on the dental anxiety evaluation tooth, MDAS, which is anticipatory nature. However, it is comparable to 16.4% documented by Locker et al.  in Canada but lower than 28.2% reported in emergency dentistry service in Brazil.  This may be explained by the fact that problem-oriented dental attendees who dominate emergency dental healthcare have a significantly higher mean dental anxiety score than regular attendees.  The higher level of dental anxiety among females found in this study concurred with findings among Jordanian undergraduates  and the higher dental anxiety in older and more experienced tutors can be explained by the documented age-wise trends of dental anxiety which is high in childhood, the decline in adolescence and increases in adulthood.  Tooth brushing and flossing were majorly considered as the best way to prevent gingival bleeding in this study. However, dental anxious participants reported lower awareness of these gingival bleeding preventive measures than the nonanxious participants. Despite the fact that dental anxious participants reported more frequent and reasonable teeth cleaning duration using acceptable cleaning aids, more interdental cleaning agent use and 3 monthly toothbrush renewal which are among the recommended norms in dental health than the dental nonanxious participants. The noted disconnect between awareness and practices need to be addressed to reinforce the oral self-care practices.
Dental anxious participants reported higher erroneous belief that gingival bleeding during teeth cleaning is a manifestation of dental caries and gingival recession than nonanxious participants. The higher erroneous belief and lower gingival bleeding preventive measures awareness may be an explanation why dental anxious participants took more improper steps for the management of gingival bleeding as they reported taking other actions other than visiting the dentist for gingival bleeding than the dental nonanxious participants. The finding that dental anxious participants visited dentist occasional or when having toothache and more reports of expensive nature of treatment, fear of dental needle, dentist, and dental clinic as their barrier to dental attendance than the nonanxious participants confirms higher dental anxiety state as a cause of delay and avoidance of dental attendance.  Irregular dental attendance has also been stated to play a major role in increasing the levels of dental anxiety. 
Dental anxious participants reported fair/poor periodontal health than the nonanxious participants. The reported higher dental treatment needs assessment among dental anxious patients may be an explanation for their poorer periodontal health rating in this study.  The fact that regular dental check-up directly affects self-rated oral health  additionally explained why dental anxious participants reported more irregular dental attendance in this study.
| Conclusion|| |
Data from this study revealed that dental anxious participants generally had better oral self-care practices, poorer gingival health, more irregular dental attendance, lower gingival bleeding preventive measures awareness, more erroneous belief, and took more improper steps for gingival bleeding management than the nonanxious participants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Darby I. Drugs and gingival bleeding. Aust Prescr 2006;29:154-5.
Grisi MF, Correa Filho TA, Fanganiello CL, Martins Júnior W, Silva-Neto CR, Salvador SL. Relationship between the presence or absence of gingival bleeding and the enzymatic BANA test. Braz Dent J 2001;12:23-6.
Muthukumar S, Anand MV, Madhankumar S. Relationship between gingival bleeding and anaerobic periodontal infection assessed by BANA (N-Benzoyl-DL-Arginine-ß-Napthylamide) assay. J Pharm Bioallied Sci 2014;6 Suppl 1:S70-3.
Bare LC, Dundes L. Strategies for combating dental anxiety. J Dent Educ 2004;68:1172-7.
Saied-Moallemi Z, Murtomaa H, Tehranchi A, Virtanen JI. Oral health behaviour of Iranian mothers and their 9-year-old children. Oral Health Prev Dent 2007;5:263-9.
Parhar G, Yoon RK, Chussid S. Maternal-child oral health behaviors and caries experience in the child. J Clin Pediatr Dent 2009;34:135-9.
Tanaka K, Miyake Y, Arakawa M, Sasaki S, Ohya Y. Household smoking and dental caries in schoolchildren: The Ryukyus Child Health Study. BMC Public Health 2010;10:335.
Bozorgmehr E, Hajizamani A, Malek Mohammadi T. Oral health behavior of parents as a predictor of oral health status of their children. ISRN Dent 2013;2013:741783.
Lalic M, Aleksic E, Gajic M, Malesevic D. Oral health related knowledge and health behavior of parents and school children. Med Pregl 2013;66:70-9.
Goettems ML, Ardenghi TM, Romano AR, Demarco FF, Torriani DD. Influence of maternal dental anxiety on the child's dental caries experience. Caries Res 2012;46:3-8.
Khawja SG, Arora R, Shah AH, Wyne AH, Sharma A. Maternal dental anxiety and its effect on caries experience among children in Udaipur, India. J Clin Diagn Res 2015;9:ZC42-5.
Sofola OO, Agbelusi GA, Jeboda SO. Oral health knowledge, attitude and practices of primary school teachers in Lagos State. Niger J Med 2002;11:73-6.
Humphris GM, Morrison T, Lindsay SJ. The modified dental anxiety scale: Validation and United Kingdom norms. Community Dent Health 1995;12:143-50.
King K, Humphris G. Evidence to confirm the cut-off for screening dental phobia using the modified dental anxiety scale. Soc Sci Dent 2010;1:21-8.
Coker AO, Sorunke ME, Onigbinde OO, Awotile AO, Ogunbanjo OB, Ogunbanjo VO. The prevalence of dental anxiety and validation of the modified dental anxiety scale in a sample of Nigerian population. Niger Med Pract 2012;62:138-43.
Arigbede AO, Ajayi DM, Adeyemi BF, Kolude B. Dental anxiety among patients visiting a University Dental Centre. Niger Dent J 2011;19:20-4.
Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res 1999;78:790-6.
Kanegane K, Penha SS, Borsatti MA, Rocha RG. Dental anxiety in an emergency dental service. Rev Saude Publica 2003;37:786-92.
Ekanayake L, Dharmawardena D. Dental anxiety in patients seeking care at the University Dental Hospital in Sri Lanka. Community Dent Health 2003;20:112-6.
Al-Omari WM, Al-Omiri MK. Dental anxiety among university students and its correlation with their field of study. J Appl Oral Sci 2009;17:199-203.
Lindsay SJ, Humphris G, Barnby GJ. Expectations and preferences for routine dentistry in anxious adult patients. Br Dent J 1987;163:120-4.
Samorodnitzky GR, Levin L. Self-assessed dental status, oral behavior, DMF, and dental anxiety. J Dent Educ 2005;69:1385-9.
Olutola BG, Ayo-Yusuf OA. Socio-environmental factors associated with self-rated oral health in South Africa: A multilevel effects model. Int J Environ Res Public Health 2012;9:3465-83.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]